Davis J C, Dian L, Khan K M, Bryan S, Marra C A, Hsu C L, Jacova P, Chiu B K, Liu-Ambrose T
Center for Hip Health and Mobility, Robert HN Ho Research Centre 2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.
Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
Osteoporos Int. 2016 Mar;27(3):943-951. doi: 10.1007/s00198-015-3350-4. Epub 2015 Oct 8.
Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers.
Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization.
This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance.
Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months.
MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls, it is important to tailor future interventions to be effective for people with MCI who fall.
ClinicalTrials.gov Identifier: NCT01022866.
跌倒在全球范围内都是一个代价高昂的公共卫生问题。现有文献中缺乏前瞻性数据来确定跌倒者中显著推动医疗资源利用的因素。我们发现认知功能——特别是执行功能——以及认知状态是老年跌倒者医疗资源利用的重要决定因素。
尽管跌倒代价高昂，但尚无前瞻性数据研究跌倒者中推动医疗资源利用的因素。我们确定了有跌倒史的老年人在6个月和12个月时医疗资源利用（HRU）的关键决定因素。具体而言，随着人们越来越认识到认知障碍与跌倒风险增加有关，我们将认知作为医疗资源利用的一个潜在驱动因素进行了调查。
这项在温哥华跌倒预防诊所进行的为期12个月的前瞻性队列研究（n = 319）纳入了在过去12个月中至少有一次跌倒史的参与者。根据他们的认知状态，参与者被分为两组：（1）无轻度认知障碍（MCI）和（2）MCI。我们构建了两个线性回归模型，每个模型分别以6个月和12个月时的HRU作为因变量。研究了与活动能力、整体认知、执行功能和认知状态（MCI与无MCI）相关的预测因素。无论统计学意义如何，均纳入年龄、性别、合并症、抑郁状态和日常生活活动。
整体认知、合并症、工作记忆和认知状态（使用蒙特利尔认知评估（MoCA）确定的MCI与无MCI）是6个月时总HRU的重要决定因素。合并症数量和整体认知是12个月时总HRU的重要决定因素。
MCI状态是有跌倒史的老年人6个月时HRU的一个决定因素。因此，为尽量减少与跌倒相关的医疗资源使用，重要的是调整未来干预措施，使其对跌倒的MCI患者有效。
ClinicalTrials.gov标识符：NCT01022866。
